The refractoriness of acute promyelocytic leukemia (APL) with t(11;17)(q23;q21) to all-trans retinoic acid (ATRA)-based therapy concerns clinicians and intrigues basic researchers. By using a murine leukemic model carrying both promyelocytic leukemia zinc finger/retinoic acid receptor-α (PLZF/RARα) and RARα/PLZF fusion genes, we discovered that 8-chlorophenylthio adenosine-3′, 5′-cyclic monophosphate (8-CPT-cAMP) enhances cellular differentiation and improves gene trans-activation by ATRA in leukemic blasts. Mechanistically, in combination with ATRA, 8-CPT-cAMP activates PKA, causing phosphorylation of PLZF/RARα at Ser765 and resulting in increased dissociation of the silencing mediator for retinoic acid and thyroid hormone receptors/nuclear receptor corepressor from PLZF/RARα. This process results in changes of local chromatin and transcriptional reactivation of the retinoic acid pathway in leukemic cells. Meanwhile, 8-CPT-cAMP also potentiated ATRA-induced degradation of PLZF/RARα through its Ser765 phosphorylation. In vivo treatment of the t(11;17) APL mouse model demonstrated that 8-CPT-cAMP could significantly improve the therapeutic effect of ATRA by targeting a leukemia-initiating cell activity. This combined therapy, which induces enhanced differentiation and oncoprotein degradation, may benefit t(11;17) APL patients.A cute promyelocytic leukemia (APL) comprises up to 10-15% of acute myeloid leukemia (AML), and its unique morphological, cytogenetic and clinical features make it a distinct AML subtype (1). The majority of these patients carry the hallmark t(15;17)(q22;q21) chromosomal translocation, which gives rise to the promyelocytic leukemia/retinoic acid receptor-α (PML/RARα) fusion gene. These leukemic cells undergo induced terminal differentiation both in vitro and in vivo upon treatment of all-trans retinoic acid (ATRA), a natural pan-retinoic acid-receptor agonist. Modern therapeutic modalities integrating ATRA in both remission-induction and postremission stages have greatly improved the 5-y survival of these patients up to 90% or even higher (2). In contrast, the 1-2% of APL patients, with t(11;17)(q23;q21) translocation that fuses the promyelocytic leukemia zinc finger (PLZF) to the RARα gene, respond poorly to ATRA treatment. In addition, these APL patients are refractory to concurrent cytotoxic chemotherapy and generally have poor outcomes (3). These features make t(11;17) APL a distinct variant from typical APL. Effective therapeutic regimens for this subtype of APL are imperatively needed.There have been sporadic case-reports documenting successful differentiation of t(11;17) APL using ATRA in combination with other differentiation inducers, highlighting the possibility and significance of reversing retinoic acid (RA) resistance in the treatment of this peculiar leukemia (4, 5). However, combinatorial differentiation inducers are usually chosen on an empirical basis, and their therapeutic mechanisms are still mostly undefined. This choice can be largely attributed to the scarcity of clinic...